ICJR ABSTRACTS: Arthroplasty Care Redesign Impacts the Predictive Accuracy of the Risk Assessment and Predictor Tool
At the 7th Annual ICJR South Hip & Knee Course, 6 awards were given to orthopaedic residents and fellows who submitted the best research abstracts in hip and knee replacement. The abstract Arthroplasty Care Redesign Impacts the Predictive Accuracy of the Risk Assessment and Predictor Tool received the Game-Changer Award: Knee Arthroplasty and was presented at the meeting by Arnold J. Silverberg, MD, on behalf of Florian Dibra, MD.
Florian F. Dibra, MD; Arnold J. Silverberg, MD; Chancelor F. Gray, MD; Hari K. Parvataneni, MD; Terrie Vasilopoulos, PhD; and Hernan A. Prieto, MD
The Risk Assessment and Predictor Tool (RAPT) is used to predict patient discharge disposition after total joint arthroplasty (TJA). Following a comprehensive, multidisciplinary redesign, our institution noticed a trend toward home discharge in patients with RAPT scores that historically predicted discharge to acute care facilities. There seemed to be an opportunity to redefine the predictive ranges for RAPT (low, intermediate, and high risk) for post-acute care facility discharge in our patient population.
Retrospectively collected data were analyzed from a single institution in patient undergoing elective primary TJA from January 2016 to April 2017. Predictive accuracy was calculated for each RAPT score (1-12), RAPT score risk ranges (low, intermediate, and high), as well as for the overall study. Other factors evaluated included patient reported discharge expectation, body mass index (BMI), and American Association of Anesthesiologists (ASA) scores as related to discharge disposition and the predictive accuracy of RAPT.
Overall RAPT predictive accuracy was 88% (n=1024 patients). RAPT scores of and had a predictive accuracy of 83% or greater. RAPT scores 4 to 7 had a predictive accuracy ranging from 52% to 79%. Patients were high risk for acute care facility with a RAPT score of 1 to 3, intermediate risk 4 to 7, and low risk 8 to 12. In multivariable analysis, RAPT score and patient-reported discharge expectation had the strongest correlation with actual discharge disposition.
Our multidisciplinary redesign has impacted the predictive accuracy of RAPT. The original predictive ranges of RAPT should be modified to reflect the overall increasing proportion of patients being discharged home following elective arthroplasty procedures. We have identified patient expected discharge destination as a powerful modulator of the RAPT score and suggest that it be taken into consideration for discharge planning.
Click the image above to watch Dr. Silverberg’s presentation of this Game-Changer Award-winning abstract.
Florian F. Dibra, MD; Arnold J. Silverberg, MD; Chancelor F. Gray, MD; Hari K. Parvataneni, MD; and Hernan A. Prieto, MD, are from Department of Orthopaedic Surgery and Rehabilitation and Terrie Vasilopoulos, PhD, is from the Department of Anesthesiology at the University of Florida College of Medicine in Gainesville.